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Tom Goom.

 

Tom is a physiotherapist with over 10 years of experience and a very keen runner! He graduated with a BSc (Hons) degree in 2002 and since then has worked in clinics in the UK and overseas. His career started in Winchester where he worked in the NHS and developed a specific interest in lower limb rehab and joined the physio team at a semi-professional football club. Following the Tsunami in 2004 Tom travelled to Sri Lanka and did voluntary physiotherapy work in a hospital, teaching local staff, treating patients and fundraising for new equipment. Tom returned to the UK in 2006 and started working in Brighton as a senior physiotherapist. His interest in rehab continued to grown and he ran lower limb and spinal rehab groups as well a chronic pain programme. Tom started RunningPhysio in March 2012 to help those training for marathons that spring, since then it’s developed into a resource used by runners all over the world. 

 

Tom Goom, The Running Physio, asks the question - is there really a magic formula or secret technique to injury free running?

By Tom Goom, The Running Physio

According to advice I've heard this week I should be a forefoot runner who avoids weight machines at all costs and cross-trains with backwards jogging! These pearls of wisdom come from articles that, though well meaning, preach that these are a must do for every runner. What's worse is they make these claims based on little or no solid evidence. Don't make the mistake of following advice that could well prove far more of a hindrance than a help!

 

Every runner is different. We have different running styles, run different distances and speeds, and have different biomechanics, genetics and body types. Our personalities are different, our goals are different, our lives are different. Why then do some feel that we should all do things the same way?

 

The temptation is, as a runner, to follow some of the advice in hope for better performance and reduced injury risk but before you do you have to ask is this really right for me?

 

One piece of advice I hear a lot is we should all forefoot strike. Often this seems based on observations that elite athletes forefoot strike and therefore we should aim to emulate them. Inextricably linked to this is we should never heel strike. Somehow heel strike seems to have become a dirty word in some circles!

 

A recent study found that 93% of marathon runners heel strike. It's not unusual, it shouldn't be feared and changing it isn't the answer to all your injury problems! The evidence behind footstrike and injury risk is far from conclusive but the impression I gain from reading the literature is the key factor it isn't how you run, but how much you run, and crucially, how quickly you change it. Whether you forefoot or heel strike a rapid increase in training volume or intensity is likely to increase risk of injury.

 

Closely linked to foot strike patterns is footwear choice. Again it appears to be a topic that polarises runners. Some insist on maximal support and others that less is best! Many runners hope that a combination of a minimalist shoe and a forefoot strike will improve performance and help with injuries. There are some circumstances where this might be the case but suggesting everyone uses this approach is reckless.

 

As a Physio I see a lot of running injuries and I frequently see injuries develop from a switch to forefoot strike and or barefoot style running, even with adequate transition time. Common problems include plantar fasciitis, "metatarsalgia", achilles tendinopathy and calf pain. My experience in clinic is mirrored by recent research which saw development of bone marrow oedema (a reaction to excessive bone stress) during transition to barefoot running. This all makes a great deal of sense when you consider the effects of forefoot running. Much of the force involved in impact is transmitted to the calf muscles with forefoot strike, increasing the load on the achilles tendon and plantar fascia. Without cushioning under the metatarsal heads they take considerable extra load too. This, to my mind, is the biggest disadvantage of forefoot strike and barefoot running - it increases the load on 3 areas commonly injured in runners - calf muscle, achilles tendon and plantar fascia. Often, in clinic, our first intervention is to switch back to a supportive shoe to reduce this load!

 

But let's not give barefoot too much bad press! There may be some evidence of benefits from this approach. By moving much of the load onto the calf complex it seems to decrease load on the knee and specifically the patellofemoral joint. Research just published in the British Journal of Sports Medicine suggests barefoot running might help with patellofemoral pain syndrome. However, I would urge caution in ditching your shoes if you have knee pain, it is a multi-factorial problem with other, arguably more evidence based solutions to try first.

 

The world of 'shod running' in supportive shoes is also not without it's controversy. There is very little evidence to support the notion of neutral, stability or motion controlled shoes as discussed expertly by podiatrist Ian Griffith in his blog. It seems that comfort is currently our best guide when it comes to selecting a running shoe.

 

Research examining running shoes has not drawn positive conclusions;

 

"PECH* running shoes have never been tested in controlled clinical trials. Their effect on running injury rates, enjoyment, performance, osteoarthritis risk, physical activity levels and overall athlete health and wellbeing remain unknown. The prescription of this shoe type to distance runners is not evidence based.” Richards, Magin and Callister (2008)

 

*PECH running shoes refer to the fairly standard design used by runners - shoes with elevated cushioned heels and pronation control features tailored to foot type.

 

So, somewhat appropriately, there is certainly no one size fits all shoe! Weigh up the risks and benefits of a big change in footwear or foot strike and ask yourself, is there a better way?

 

Another area where one size fits all advice is common is injury management. The more you delve into running injuries the more you realise how complex they can be and how telling someone they must do or must never do something is rarely wise! The biggest culprit in running is probably stretching. It's our first instinct when something feels tight and many people's first piece of advice - "have you tried stretching it?" Sometimes though stretching can really aggravate a problem and delay its healing. A good example is tendinopathy; stretching has little benefit and in many cases will aggravate by causing compression of the tendon against its bony attachment.

 

My final bug bear is strength and conditioning advice. There are so many 'musts' for runners. You must do core work. You must do yoga. You must do strength training and it must be 'functional'. There are 'must nots' too - you must not use weight machines, and must not do glutes exercises in lying. The list goes on and on and yet it's quite likely that following some of these 'must' or 'must not's' has little or no benefit to you as a runner.

 

There is no quality research evidence to show that 'core work' improves running performance or reduces injury risk in runners. There is no reason to avoid machine weights, they can be used as part of a strengthening programme that improves running economy and in the treatment of a number of conditions. Glutes exercises can certainly be done in sidelying and doing it in this way achieves high levels of glute med activation needed to create strength changes. That said, I'm not dismissing core altogether, saying we must all do weights or that only sidelying exercises are good for glutes!

 

For every approach there are pros and cons, arguments for and against. We need to embrace a balanced view of our options and ask those providing advice 'what is the evidence to support this?'

 

There are very few bits of advice that are likely to work for all runners. If I were to give one piece of advice (not a must do just a suggestion) it would be this - change training gradually;

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...but even that advice has little research evidence to show it reduces injury risk and some may feel they need large changes in training to improve performance. Like I said, there are pros and cons of everything, no must do's and no one size fits all approach!

 

In conclusion; whenever receiving advice take it with an open mind. Ask yourself is this the best option for me? Is there good evidence that this will help me manage injury or improve my performance? Have I got all the information or just been delivered one side of it?! The more you look, the more you find that there is little or no good evidence to support a drastic change.

 

With extremes of opinion often the truth lies somewhere in the middle.

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